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J Thorac Cardiovasc Surg 1997;113:1127-1128
© 1997 Mosby, Inc.

LETTERS TO THE EDITOR

Twenty-three–year survival of a bovine pericardial bioprosthesis

Leeds General Infirmary
Great George St.
Leeds, LS1 3EX, United Kingdom

To the Editor:

The letter by Trujillo and colleagues ¹ concerning a 19-year survival of a Hancock I porcine mitral bioprosthesis (Johnson & Johnson Cardiovascular, King of Prussia, Pa.) prompts us to report this 23-year survival of a bovine pericardial bioprosthesis in the aortic position.

A male patient was noted to have a cardiac murmur on routine medical examination at the age of 11 years. In 1972, at the age of 36 years, he was referred for treatment because of a 3-year history of dizziness, double vision, and progressive dyspnea on moderate exertion. A diagnosis of aortic stenosis was made. The patient was not evaluated by cardiac catheterization. On October 10, 1972, he underwent aortic valve replacement. A heavily calcified bicuspid aortic valve was excised and replaced with a 20 mm standard-profile Ionescu pericardial xenograft that had been constructed by the surgical team at the Leeds General Infirmary. He made an uncomplicated postoperative recovery. No anticoagulants or antiplatelet agents were administered after the operation.

The patient returned to work as a nurse. He continued to pursue active sporting hobbies and was walking in the Austrian Alps in July 1995 and regularly playing badminton until April 1996. He was followed up on an annual basis in the surgical outpatients' clinic. A routine echocardiogram in March 1996 showed mild stenosis across the aortic xenograft with a gradient of 33 mm Hg. One month later he was admitted on an emergency basis after an episode of severe chest pain. He had become acutely breathless and was noted to have a cardiac murmur. Clinical examination at this point revealed severe aortic regurgitation. This was confirmed by transesophageal echocardiography. Coronary angiography revealed additional triple-vessel coronary artery disease.

On April 30, 1996, he underwent a second aortic valve replacement and quadruple coronary artery bypass grafting. At the operation the prosthesis was noted to be moderately calcified. A tear extended from the apex of one of the stent posts to the base of the leaflet. At the patient's request a Carpentier-Edwards bioprosthesis (Baxter Healthcare Corp., Edwards Division, Santa Ana, Calif.) was used to replace the previous xenograft. He made an uncomplicated recovery and was discharged to his home on the eleventh postoperative day.

This particular bioprosthesis was inserted 1 year after Mr. Ionescu began constructing and implanting bovine pericardial bioprostheses. Thus this represents the longest surviving bovine pericardial xenograft inserted at this institute. This particular case confirms that the bovine pericardium can be a suitable material for the construction of cardiac valvular bioprostheses. The large variation in rates of structural deterioration suggests that the design and the construction of the valve, together with individual patient variables, are major determining factors in their rates of failure. ²

12/8/80738

References

1. Trujillo J, Llana R, O'Connor F, Alswies A, Gil-Aguado M. Extended survival with a porcine mitral valve bioprosthesis. J Thorac Cardiovasc Surg 1996;112:1407-8.[Free Full Text]
   
2. Wheatley DJ, Crawford FA, Kay PH, Chandler JG, Strong MD III, Strom JA, et al. A ten year study of the Ionescu-Shiley low profile bioprosthetic valve. Eur J Cardiothorac Surg 1994;8:541-8.[Abstract]
   

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Philip H. Kay Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Oswal, D. Articles by Kay, P. H. Search for Related Content PubMed PubMed Citation Articles by Oswal, D. Articles by Kay, P. H.